Methods of root canal and periodontal therapy



A. J. HIRSCH 3,035,351

METHODS OF ROOT CANAL AND PERIDONTAL THERAPY May 22, 1962 Filed April 27, 1960 INVENTOR. ARNOLD J. HIRSCH, D.D. S. M) W United States Patent 3,035,351 METHODS OF ROOT CANAL AND PERIODONTAL THERAPY Arnold J. Hirsch, Franklin Park, NJ. (211 N. Harrison St, Princeton, NJ.) Filed Apr. 27, 1960, Ser. No. 25,137 2 Claims. (Cl. 32-40) This invention relates to: improved methods of root canal and periodontal therapy and to improved instruments for carrying out these methods.

In the treatment of a root canal or a periodontal area of a tooth, it is necessary during the procedure to remove unwanted tissues and debris which may have accumulated in the regions of treatment; and in root canal therapy, it is necessary to sterilize the regions of the tooth being treated. Previous methods generally try to accomplish this by mechanical means followed sometimes by forcing liquids, usually containing medicaments, through hollow needles introduced into the areas of treatment. In root canal therapy previous methods are only partially successful since many auxiliary canals or involved areas are already filled with liquid and/or tissue and other areas are simply difiicult to reach. By previous procedures, therefore, the regions of treatment may be subject to bacterial action within or decomposition of the debris or both within the regions, or of the areas adjacent to the regions of treatment.

Further, instruments comprising hollow needles are available in various diameters and lengths. Generally, such needles are fabricated with a pointed, sharpened end. When introduced into regions of limited access in or adjacent to a tooth, the point of these needles tends to stick into the tooth or tissue walls, barring further access therein. For example, a conventional needle inserted into a root canal tends to stick in the wall of the canal, especially if the canal is curved, barring further access into the canal. Also, a conventional needle inserted into a periodontal pocket adjacent a tooth tends to stick in the sides of the tooth or in the tissue forming the pocket. Forcing a conventional needle which has stuck could cause additional damage to the dental and periodontal areas without gaining additional access into the regions of treatment.

An object of this invention is to provide improved methods for root canal and periodontal therapy.

A further object is to provide improved methods for irrigating and sterilizing root canals and periodontal areas.

Another object is to provide improved instruments for root canal and periodontal therapy.

Still another object is to provide improved instruments for irrigating and sterilizing root canals and periodontal areas.

As applied to root canal therapy, the methods of the invention follow the opening into the pulp chamber of a tooth, loosening and removal of pulp tissue from the pulp chamber and the root canal in the usual manner. As applied to periodontal therapy, the methods of the invention follow the entry into the periodontal area adjacent to a tooth and the removal of the undesired tissue in the usual manner. Following this, the regions of treatment may be irrigated and flushed according to the invention, by introducing a hollow needle into the region of treatment, as into the bottom of a root canal or into the periodontal region, and then passing controlled dosages of steam or steam mixed with a coolant through the needle into said region. Steam issuing from the needle pervades the entire region and contacts all of the surface areas in the region of treatment thereby rendering much of the bacteria therein inactive and, at the same time, flushes debris from the most inaccessible parts of the region. Further, should any debris remain, it is nevertheaaaaasi Patented May 22, 19 52 less bacterially inactive as a result of the action of the steam thereon either because of the killing of the bacteria or the reduction in quantity or concentration of viable pathologic organisms.

The invention includes also instruments adapted to carry out the processes of the invention. Such instruments comprise a hollow needle having two ends, a connection at one end thereof adapted for introducing steam into the hollow portion thereof, the cross section of the other end being less than the cross section of the root canal of a tooth, said other end further being ovate or torpedo shaped. By virtue of the size and shape of the other end of the needle, said other end will slide in the root canal or periodontal regions without sticking into the Walls thereof.

The invention is more fully described below in conjunction with the accompanying drawing in which:

FIGURE 1 is a fragmentary, sectional, elevational view of a tooth and adjacent regions, illustrating the treatment of the root canal thereof by a method of the invention,

FIGURE 2 is an enlarged and fragmentary view of the bottom of the root canal of the tooth of FIGURE 1, illustrating in detail the passage of steam therein and the shape of the end of a needle of the invention,

FIGURE 3 is a sectional, elevational view of a tooth illustrating the treatment of a periodontal area thereof by a method of the invention, and

FIGURE 4 is a fragmentary, elevational view of the end of another needle of the invention.

Similar reference numerals are used for similar structures throughout the drawing.

Root Canal Therapy.FIGURES 1 and 2 illustrate the method of the invention applied in root canal therapy. A tooth 21 comprises an enamel layer 23, a dentin portion 25, and a pulp cavity 27. The tooth 21 is to be treated to remove a portion of the pulp tissue, including the nerves and blood vessels from the pulp cavity 27 in one of the root canals 29 in one root 28 of the tooth 21. A region 45 of pathosis of the bone 47 adjacent to the apex 30 (or end) of the root 28 is to be irrigated and sterilized. Portions of the enamel 23, of the dentin 25, and of the pulp 27 is removed to provide continuous access 31 into the lower interior portion of the root canal 29 of the tooth 21. The upper portions of the tooth 21 are removed by drilling. Since the root canal 29 is not easily accessible, techniques for removing the pulp tissue other than drilling must be resorted to. One method of removing the pulp tissue in the root canal 29 is to insert into the root canal 29 a nerve broach which is in the form of a fine wire having burrs along the length thereof. The broach is rotated to twist the pulp tissue thereabout, after which the broach is removed, carrying part or all of the pulp tissue with it. Then the root canal 29 is enlarged by abrading the surfaces thereof with files and rearners. Following the loosening of the remaining pulp tissue (if any) and undesired tissue and the enlargement of the root canal 29, the continuous access 31 and the region of pathosis 45 are irrigated and sterilized by the method of the invention. According to the invention, a needle 33 having a continuous passage 39 therethrough is connected to a source of steam and a control (not shown) through a flexible hose 37 and a connection 35 at one end thereof. The other end 41 of the needle 33 is passed down beyond or up to the apex 30 of the root canal 29 through the continuous access 31. Steam is passed down the passage 39 of the needle 33 into the root canal 29 while the needle 33 moves toward the apex 30 of the root canal and for a period of time thereafter. The steam and condensate thereof and liquid already in the root canal 29 all rise in the access 31, as shown by arrows 43, carrying with it debris from the treated region in the root canal 29. At the same time, due to the high temperature of the steam, the liquid rising in the access 31 increases in temperature to the point at which it sterilizes the surfaces of the access 3 1 by killing or rendering the bacteria thereon inactive. Additionally, it will be noted that the one end 41 of the needle 33 extends beyond the apeX 30 into a region 45 of pathosis of the bone 47. The steam issuing from the needle also flushes and sterilizes this region 45 of pathosis of the bone 47.

After the sterilization and flushing action is completed, the needle 33 is removed and the open portion of the tooth is filled by conventional methods with suitable materials.

The novel methods of sterilizing and flushing the root canal described herein are simple to carry out and yet are more complete in their action than previous methods, which involve repeated introduction of absorbent points dry or soaked or with medicament in order to sterilize the regions of treatment. Further, previous methods depend on actually physically contacting all of the surfaces to be sterilized during the repeated introduction of the instruments or absorbent points. The methods of the invention are less time consuming, and more complete by the more thorough sterilization and irrigation of the auxiliary canals and regions of pathosis 45.

Steam has previously been suggested as the acting agent for sterilizing areas of a tooth. These previous methods apply relatively large amounts of steam from points external to the root canal to relatively large areas of the tooth and adjacent areas. As a result of the use of large amounts of steam so generally applied, much damage may be done to vital tissue not under treatment. The methods of the invention are distinguished from these previous methods by applying markedly smaller, carefully controlled amounts of steam directly into the region to be treated so that it does not adversely affect other vital areas.

Periodontal Therapy-The methods of the invention may also be applied to the periodontal regions of a tooth. Periodontal regions, which have become pathologic, frequently must be cleaned, undesirable or abnormal tissue removed therefrom, and the region flushed free of debris.

FIGURE 3 illustrates the novel methods herein applied to periodontal therapy wherein teeth 51, 53, and 55 extend from the bone 57 through the gum 58. A periodontal pocket region 59 of tooth 55 is to be treated. Pathologic or otherwise unwanted tissue and debris are loosened and removed by surgical or mechanical action in the conventional way. Following treatment in the conventional way, the pocket region 59 is flushed by introducing the end of a hollow needle 61 into the region 59. Because of its small size and the geometry of its free end 63, the needle slips easily to the bottom of the pocket region 59. Small, controlled quantities of steam are then passed into the needle through the hose 37 and the connection 35. The steam issues from the end 63 of the needle 61 and passes upwardly through the pocket 59 irrigating the pocket 59. In its passage, the steam heats its condensate and liquids already therein to the point where the liquids kill much bacteria in the periodontal pocket 59 by the action of the heat. The heat further enhances blood clotting and coagulation. The region then heals in a conventional manner.

Needles-The method is greatly facilitated in the design of the free end of the needle. As shown in FIGURE 2, the needle end 41 has an ovate, or topredo, or cigar shape. The end 41 has a curved contour with no sharp point or edges thereon. Such contour permits the point 41 to slip easily into narrow constricted and difiicultly accessible parts of the regions of treatment. A spherical end also functions in this way. Previous needles are equipped with sharp points which tend to lodge in the solid interior of the walls of the root canal and of the periodontal regions. Further, the needle has an outside cross section less than the cross section of the region to be treated.

FIGURE 3 illustrates a needle 61 having a bend 65 therein to facilitate reaching some more ditficultly accessible regions of a tooth.

The needle illustrated in FIGURE 2 has a simple passage 39 extending to the end 41 thereof. FIGURE 4 illustrates another needle equipped with a spherical end 73. The needle 71 has a central manifold passage 75 which may extend to the end or almost but not all the way to the end. The needle 71 also has several transverse passages 77, which extend from the central passage 75 terminating at ports 79 in the side of the needle. The needle 71 of FIGURE 4 is especially useful in flushing and sterilizing regions adjacent to the ports 79.

What is claimed is:

1. A method of treating a region of pathosis in the jawbone adjacent the apex of the root of a tooth comprising removing portions of the enamel, dentin, and pulp tissue to provide a continuous access into said region of pathosis, introducing a hollow needle through said continuous access and into said region of pathosis, passing small controlled quantities of steam through said needle into said region of pathosis, and permitting said steam and the condensate thereof to pass from said region through said access along the outside of said needle.

2. A method of treating a region of pathosis in a periodontal region of a tooth comprising providing a continuous access into said region of pathosis, introducing a hollow needle through said continuous access and into said region of pathosis, passing small controlled quantities of steam through said needle into said region of pathosis, and permitting said steam and the condensate thereof to pass from said region through said access along the outside of said needle.

References Cited in the file of this patent UNITED STATES PATENTS 408,899 Small Aug. 13, 1889 1,573,749 Ross Feb. 16, 1926 2,276,623 Meiman Mar. 17, 1942 2,704,076 Larson Mar. 15, 1955 2,923,294 Reimann et al. Feb. 2, 1960 

